Annals of Surgical Oncology

, Volume 23, Issue 3, pp 1036–1043 | Cite as

Optimization of Free-Flap Limb Salvage and Maximizing Function and Quality of Life Following Oncologic Resection: 12-Year Experience

  • Edward I. Chang
  • Alexander T. Nguyen
  • Jennifer K. Hughes
  • Julie Moeller
  • Hong Zhang
  • Melissa A. Crosby
  • Roman J. Skoracki
  • David W. Chang
  • Valerae O. Lewis
  • Matthew M. Hanasono
Reconstructive Oncology



A knowledge gap exists regarding factors to optimize limb salvage and function following oncologic resection.


We conducted a retrospective review of all free flaps performed for upper extremity (UE) and lower extremity (LE) salvage from 2000 to 2012.


Overall, 220 patients underwent free-flap reconstruction for limb salvage (UE: 64, and LE: 156). Flaps were classified as muscle-only (n = 77), myocutaneous (MC; n = 67), or fasciocutaneous (FC; n = 76). Smoking, diabetes, peripheral vascular disease, and prior chemotherapy or radiation had no impact on complications, while osteomyelitis significantly increased the risk of infection (odds ratio [OR] 19.5, confidence interval [95 % CI] 3.77–100.64; p = 0.0004), wound healing complications (OR 7.51, 95 % CI 2.21–25.49; p = 0.001), and amputation (OR 4.63, 95 % CI 1.41–15.19; p = 0.01). Hardware increased the risk for flap loss (OR 4.92, 95 % CI 1.33–18.23; p = 0.017). MC and FC flaps had increased risks for hematoma (p = 0.02) and reoperation for microvascular complications (p = 0.005) but were at lower risk for infection (OR 0.14, 95 % CI 0.02–0.87; p = 0.03) compared with muscle-only flaps. There were a total of seven total flap losses (3.2 %), with significantly increased risks for MC/FC flaps (OR 2.58, 95 % CI 1.06–6.26; p = 0.03). For LE, 103 patients (66.3 %) were fully ambulatory, while 23 (14.7 %) were ambulatory with assistance (mean Musculoskeletal Tumor Society score (MSTS) 80.2, and Karnofsky score 84.0). For UE, 49 patients (76.6 %) were able to perform their activities of daily living independently (mean MSTS 80.2, and Karnofsky score 86.0). Overall, 190 patients (86.4 %) were successfully salvaged.


Free flaps can be performed reliably for limb salvage following tumor extirpation. While MC/FC flaps demonstrated improved postoperative function, they were at significantly higher risk for take-backs and total flap loss.


Osteomyelitis Free Flap Limb Salvage Oncologic Resection Karnofsky Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Edward I. Chang
    • 1
  • Alexander T. Nguyen
    • 1
  • Jennifer K. Hughes
    • 2
  • Julie Moeller
    • 2
  • Hong Zhang
    • 1
  • Melissa A. Crosby
    • 1
  • Roman J. Skoracki
    • 1
  • David W. Chang
    • 3
  • Valerae O. Lewis
    • 4
  • Matthew M. Hanasono
    • 1
  1. 1.Department of Plastic Reconstructive SurgeryMD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Rehabilitation MedicineMD Anderson Cancer CenterHoustonUSA
  3. 3.Section of Plastic Surgery, Department of SurgeryUniversity of ChicagoChicagoUSA
  4. 4.Department of Orthopedic SurgeryMD Anderson Cancer CenterHoustonUSA

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